A New First - Emergency Room

Since Botox was injected into Les' saliva glands, his swallowing has been compromised.  We believe it's from the Botox; we won't know for sure until the Botox wears off. Anyway, Sunday morning Les had his second choking episode in a week.  He believes he had acid reflux come up and since he can't swallow, he can't do anything about it.  He chokes quite a bit and uses his suction machine and cough assist to try to move things in his throat.   He panicked a little this second time and had me text Dr. Steve (his doctor here in town) and also neighbor nurse Kay.   Kay was able to pop in and check Les out and Dr. Steve called a couple times.  They were both a little concerned; Steve said if Les continued to have labored breathing he should have an X-ray of his lungs--aspirating is a huge concern for ALS patients.

After Les had a small feeding, he was still having trouble catching his breath and felt like he had phlegm in the base of his throat that his suction machine couldn't reach. He made the decision to go in to ER and get rid of that phlegm.   We got right in and didn't wait too long for a doctor!  He ordered X-rays of Les' lungs and throat/vocal chords.  The X-rays showed his lungs were clear, which was good news!  Since Les still had difficulty breathing, the ER doctor called in an Ear/Nose/Throat specialist.  We waited quite a while for him to get there.  There is definitely entertainment in the ER - we had a drunk/high person across the hall screaming at the top of his lungs.  And he wasn't screaming nice things! :)   But it was still a long afternoon.

The Dr. who came was the same ENT doctor Les saw a year ago before his ALS diagnosis.  We like him, he is very matter of fact and efficient.  He did a scope through Les' nose to see what was going on in Les' throat.  This Dr. also noted that Les' vocal chords are not working properly and there was mucus pooled behind his vocal chords - which was what Les could feel but couldn't get rid of.  He explained that this is probably the disease progressing.  There is a slight possibility it could be from the Botox but we wouldn't know that until the Botox wears off in 6 weeks or so.  The vocal chords also affect our breathing so that is why Les has experienced more difficulty in breathing.  The Dr. said this will more than likely keep happening.  If it gets to the point where Les can't breath, then a breathing tube would need to be inserted.  The Dr. suggested a few meds that Les can try to thin the mucus so it doesn't pool.

We will pass this information on to our Dr. and nurse Jen at the UW and find out if they have any further insight.  Thank you to nurse Kay (and her husband) for visiting twice.  She is a blessing to have as a neighbor.   Les' sister just mailed us these sweet little cards to hang wherever we choose.  Perfect timing Linda.